[Question #1120] HPV

51 months ago
Hello Doctor. I am a 26 year old female, I am going to tell you a little about my story. I apologize for my English because I only speak Spanish. By the month of April this year i went to my gynecologist because i have irritation on my genitals when He examine me he told me that I had herpes. I did blood tests which were positive for HSV-1, plus a culture of the infected area that the doctor take for evaluation, which came out negative for herpes. In addition I did a test pap which was normal. Then, by the end of June I went to a follow-up appointment to check that all was well with herpes, because I took Acyclovir (if I remember correctly that was the name) for two weeks, when my gynecologist verify me the herpes had healed but He notice that i have small warts that seemed like hpv. For the month of July I decide to have an examination of pap in conjunction with the HPV test and the results were as follows: the pap present ASCUS and positive for one or more high risk HPV, but negative for HPV 16 and 18. I was also using Aldara for genital warts, which has turned out very well, warts are barely visible. My gynecologist decides to make a colposcopy and biopsy. The biopsy results came back negative. So my gynecologist indicated me to wait a year to make another pap test. After telling my story I'm going to make my questions, which I understand are very common, but the information of HPV that you search in the internet is very confusing. I inform you also that I only had sex with two men, one of them was a monogamous relationship that last for 8 years, the other was with a man which had many sexual partners in the past and who i do not know his status. I took tests of HIV, gonorrhea, syphilis, chlamydia, etc, four months and 6 months of my last risk exposure and all of them were negative. 

1. Having both HSV 1 and HPV high-risk and low-risk decreases the chances of eliminating the HPV virus ?

2. I am concerned about oral hpv and about my risk of developing warts in the mouth or developing oral cancer,do I need to take some test to rule out any chance? I

3. How common is oral cancer or to develop warts in the mouth?

4. I understand that for herpes, if you have it in a body part, such as in the mouth, makes you immune in other parts of the body  (I do not know if I'm right), it is similar for hpv? If I have high risk hpv in the genital area, could I have it in the mouth?

5. I have made only oral sex to one man, that is my current partner, and I think that he would already have the same infections that I have, how possible is for me to have oral hpv, to develop warts or cancer?
6. I'm afraid that my partner can present warts in the future, so I decided not to have sex until I can get rid of my warts completely, is the best decision or you understand that I must continue my normal sexual life, but using condoms to reduce the risk?
7. My partner and I plan to have a baby soon, how long should webwait to have unprotected sex, would be better to wait about a year and see my results of a new examination of pap and HPV?
8. How often recurrences occur?

Thank you very much for your time, and sorry for asking all these questions, but the information that I find in the web is so confusing.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
 Welcome to the forum. Unfortunately, your question far exceeds the limit of 1500 characters (about 300 words). See the instructions, first bullet under "How it Works".  You must have written it in Word or similar program, and then pasted it; otherwise the forum software would have cut you off at 1500 characters. Please shorten your question and re-post it below, then I will respond. Thanks.

HHH, MD
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51 months ago
Hello Doctor. I am a 26 year female. I have HSV 1 in my genital area. This month of July the results of my pap present ASCUS and positive for one or more high risk HPV, but negative for HPV 16 and 18. The results of my biopsy were negative. I also have small warts in my genital area. I've only had sex with only two men.  My blood test of stds including hiv 4 months and 6 months after my last risk exposure, all of them were negative. 
Having both HSV 1 and HPV high-risk and low-risk decreases the chances of eliminating the HPV virus ?
I am concerned about oral hpv and about my risk of developing warts in the mouth or developing oral cancer,do I need to take some test to rule out any chance? I
How common is oral cancer or to develop warts in the mouth?
I understand that for herpes, if you have it in a body part, such as in the mouth, makes you immune in other parts of the body  (I do not know if I'm right), it is similar for hpv? If I have high risk hpv in the genital area, could I have it in the mouth?
I have made only oral sex to one man, that is my current partner, how possible is for me to have oral hpv, to develop warts or cancer? 
I'm afraid that my partner can present warts in the future, so I decided not to have sex until I can get rid of my warts completely, is the best decision or you understand that I must continue my normal sexual life, but using condoms to reduce the risk?
My partner and I plan to have a baby soon, how long should we wait to have unprotected sex?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Thanks for the shortened question!  I'm happy to help.

First comment:  Genital herpes due to HSV1 usually is a non-problem. Most persons have few or no recurrent outbreaks, and asymptomatic viral shedding -- and hence infectivity for partners -- is infrequent. Most people with genital HSV1 don't have any significant problem with it and never transmit it to partners.

As for HPV, your cervical infection clearly is doing nothing serious at this point. ASCUS is not really abnormal and not a cancer risk. And with a normal biopsy, this really isn't a worry. Follow your doctor's advice about follow-up pap smears and/or colposcopy, but probably it will never be a problem for you. I'm not sure what to make of having "small warts" in the genital area. Are you certain? Professionally diagnosed? The high risk types, for which your cervix was positive, generally do not cause warts. If there is any doubt, get a second opinion, perhaps from a dermatologist.

And of course I'm glad to hear your HIV blood test was negative. I'm not sure what to make of "other" STD blood tests. Probably negative syphilis, but of course it would be expected your HSV1 blood test was positive. I hope you were tested for gonorrhea and chlamydia, which are not tested in blood).

Now to your specific questions:

HSV1 and HPV:  There are no known interactions. Neither makes any difference in the other, and HSV doesn't reduce the very high likelihood that your immune system will eliminate your HPV.

You could have oral HPV, but probably not. If you do, it will never cause a problem and won't be transmitted to partners, and probably will be cleared by your your immune system even more rapidly than your cervical infection. There is no realistic chance you'll get oral cancer. HPV type 16 is the only one that causes oral cancer, and even that usually does not do so -- and when it does, typically it's 30-40 years later. And in any case, even though throat cancer due to HPV 16 is increasing, it remains a rare problem. Even in people with very frequent oral sex, the frequency of HPV cancer is far lower than everyone's risk of other common cancers like breast, colon, lung, etc. As for warts, in my 40 years in the STD business, I have never seen a case of oral warts except in gay men with AIDS. It's really not something to be concerned about. You are correct about transfer of HSV to new areas of the body -- very rare. It's less clear with HPV, but probably also very infrequent.

Your questions suggest you are quite obsessed with oral HPV. Dont be!  It's almost never a problem in people like you.

Finally, there is no point in not having sex with your partner. He already is exposed to your HPV infection, and likely infected. Or maybe he was even the source of your infection. Either way, avoiding sex now will not change anything. You're not protecting him from anything, and I advise the two of you to ignore HPV and enjoy rewarding, mutually satisfying sex with one another. Get started tonight!

Try to get a realistic perspective on HPV. Having it is normal; it happens to almost all sexually active people. You're just like everybody else -- nothing special going on in your case. Don't let this very minor viral infection have any sort of major impact on your life. Most infections are an inconvenience, not an important health risk.

Finally, both you and your partner should be vaccinated against HPV. The vaccine is highly effective, and it will prevent infection with 9 of the HPV types that cause 90% of cancers and warts (not counting the type[s] you already have.

I hope this has helped. Let me know if anything isn't clear. Best wishes--  HHH, MD

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51 months ago
Dr. thank you very much for your reply. It is a great relief for me.  Sorry for my english, Im a latin girl, so I only speak spanish. My gyn told me I had genital warts. I used Aldara for two weeks and It  turn out very well, because You can barely see them. As for the vaccine my gynecologist gave me the prescription, but I'm afraid, first because i don't know how safe it is, and I've read on the internet about side effects, even deaths from the vaccine. It scares me a little that. Would you recommend me to get vaccinated? My partner is 27, I read that men can only get vaccinated before 21 years, could he  still be vaccinated?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
OK re warts; I'm glad they are improving.

The HPV vaccine is completely safe. You found false information on line:  there are no serious side effects and certainly no deaths from the HPV vaccine. The worst is a little pain at the injection site for a few days. I still recommend you be vaccinated. It is less important if your current partner will be your only partner. However, it is difficult to predict the future; if you have other partners someday, you will wish you had been vaccinated.

The guidelines in most countries are to vaccinate up to age 26, not 21 -- but maybe different in your country. But at age 27, probably it is not necessary for your partner.

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50 months ago
Hi. Sorry to bother again. Thank you for all your answers, they've help me a lot!!!!. My partner and I have in our plans to have a baby soon, I wanted to ask: 1. My gyn indicated me to wait a year to take the pap and HPV test again, that's the time indicated or recommended are 6 months? 
2. It is recommendable to wait for the next result of pap and HPV test to see if I have already eliminated high risk hpv or we can start trying to have a baby? 
3. Is there any recommendation to eliminate faster HPV, some vitamins or some modification of lifestyle?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
1) The reason for repeat pap smear is to detect pre-cancerous changes before they develop into actual cancer. That usually takes 5-10 years or more, so repeat testing at one year is just fine.

2) Some doctors recommend delaying pregnancy in this situation, but many do not. Pregnancy naturally suppresses the immune system and might delay HPV clearance. On the other hand, millions of women get pregnant without knowing they have HPV, and millions of babies each year are conceived and born to women with HPV, with no harm to them or to the infected women.

3) If you smoke, stop. Tobacco use delays HPV clearance. Of course good health habits always are recommended, especially in pregnant women and those attempting to conceive (diet, exercise, rest, avoiding excessive drugs and alcohol). But unfortunately these, or vitamins, won't make much difference in HPV clearance.

That completes the two follow-up comments and replies included with each question, and so ends this thread. I'll leave it open a few hours in case you have any final brief questions, but then it will be closed.

I hope this discussion has been helpful. The main point is that your situation is very common; your HPV will clear up without causing any harm; and if you follow your doctor's advice about follow up pap smears etc, you'll never have an important health issue from your HPV.

Best wishes for your family plans!  
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